| NPI | 1124723374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MO 2026021839) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2026021839) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: IL 019.034392) | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-07-09 |